| NPI | 1538432737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC CO15083) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-24956) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 1041C0700X Social Worker, Clinical (Licence: NC P014395) | |
| Enumeration Date | 2012-02-17 |
| Last Update Date | 2023-09-25 |